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Borderline Personality Disorder in Gorenstein and Comer

Case Analysis at Treatment Format
Prior to beginning work on this weeks journal, read the PSY650 Week Four Treatment Plan ,Preview the document Case 15: Borderline Personality Disorder in Gorenstein and Comer (2014), and Borderline Personality Disorder in Sneed et al., . (2012). Please also read the Rizvi, et al. (2013), “An Overview of Dialectical Behavior Therapy for Professional Psychologists,†Harned, et al. (2013), “Treatment Preference Among Suicidal and Self-Injuring Women with Borderline Personality Disorder and PTSD,†Miller (2006), “Telehealth Issues in Consulting Psychology Practice,†and Luxton, et al. (2011), “mHealth for Mental Health: Integrating Smartphone Technology in Behavioral Healthcare†articles.

Assess the evidence-based practices implemented in this case study. In your paper, include the following.

Explain the connection between each theoretical orientation used by Dr. Bank’s and the interventions utilized in the case.
Describe the concept of dialectical behavior therapy, being sure to include the six main points of this type of treatment.
Explain Dr. Banks’s primary goal during the pre-treatment stage and how Dr. Banks related this to Karen in her initial therapy sessions.
Describe the two formats that Dr. Banks told Karen would be part of her treatment program.
Describe the focus of the second and third stages of treatment.
Assume the role of a consulting clinical or counseling psychologist on this case, and recommend at least one technology-based e-therapy tool that would be useful. Explain liability issues related to delivering e-therapy consultation, supporting your response with information from the Miller (2006), “Telehealth Issues in Consulting Psychology Practice†article.
Evaluate the effectiveness of the treatment interventions implemented by Dr. Banks supporting your statements with information from the case and two to three peer-reviewed articles from the Ashford University Library, in addition to those required for this week.
Recommend three additional treatment interventions that would be appropriate in this case. Use information from the Sneed, Fertuck, Kanellopoulos, and Culang-Reinlieb (2012), “Borderline Personality Disorder†article to help support your recommendations. Justify your selections with information from the case.
The Case Analysis – Treatment Format

Must be 4 to 5 double-spaced pages in length (not including title and references pages) and formatted according to APA style as outlined in the Ashford Writing Center (Links to an external site.).
Must include a separate title page with the following:
Title of paper
Student’s name
Course name and number
Instructor’s name
Date submitted
Must use at least two peer-reviewed sources from the Ashford University Library in addition to the article required for this week.
Must document all sources in APA style as outlined in the Ashford Writing Center.
Must include a separate references page that is formatted according to APA style as outlined in the Ashford Writing Center.

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Evidence-based practice: borderline personality disorder

Theoretical orientation of interventions

Oneintervention used by Dr. Banks is dialectical behavior therapy(DBT) which is based on biosocial theory. This theory posits that disorders, disabilities and mental illnesses are personality traits determined by biology reacting to environmental factors. Developed by Marsha Linehan, DBTis evidence based treatment approach that combines cognitive behavioral therapy techniques, reality testing and Buddhist meditative concepts for cognitive and emotional regulation.

Dr. Banks also utilizes behavioral skills training (BST) to equip Karen with the skills necessary to cope with the BPD and to improve her life. BST has the steps of instructions, modelling, rehearsal and feedback to teach the learner new skills. It is based on applied behavior analysis that assesses the functional relationship between a targeted behavior and the environment so as to develop a desired alternative behavior.

The doctor also applies individual psychotherapy with a psychodynamic slant as posited by Sigmund Freud where the doctor developed a close therapeutic relationship with Karen with a view to exploring and positively influencing the latter’s thoughts, feelings and behaviors.

Another psychodynamic approach employed by the doctor is imaginal exposure where the doctor made Karen confront her feared childhood memories regarding physical and sexual abuse. This approach can be traced to the behavioral psychologists James Taylor and Joseph Wolpe who employed it with response prevention for such situations as anxiety and phobias.

Dialectical behavior therapy

Dialectical behavior therapy (DBT) is based on a recognition that the failure to have stable and easily controllable emotions emanates from invalidation during childhood, where the thoughts and feelings of the person were not taken seriously or were not supported. Developed for borderline personality disorder and chronic suicidal thoughts, it has been successfully used in treatment of depression, substance use, binge eating, among other diagnosis. The evidence-based treatment intervention is employed to incessantlysteady and fuse acceptance and change-oriented strategies.

There are six main points that differentiate DBT from other behavioral therapies. These points include support where the psychologist assists the client to appreciate, develop and utilize their strengths and attributes. Another point is behavioral where the client learns to analyze problems and or negative behavior pattern, replacing such problem or behavior with positive and healthy behaviors. There is also the cognitive point where the client aims to change ineffective or unhelpful thoughts, beliefs and behavior. The fourth main point of DBP is the client learning new skill sets so that they are able to improve their life. Acceptance and change is a point that involves the client accepting themselves, their emotions and their lifein general. They are also able to make positive changes in their behaviors ad relationships. Collaboration is the sixth main point of DBP and involves learning and effecting communication and teamwork.

Pre-treatment goal

The aim of the pretreatment stage was to get Karen to commit to dialectical behavior therapy for a minimum period. This is because persons afflicted by borderline personality disorder are predisposed to “impulsive, premature terminations of therapy”.

Obtaining the commitment involved Dr. Banks gaining Karen’s trust so that thepatient can easily accede to the doctor’s recommendation. Consequently, Dr. Banks got Karen to narrate her history, with the doctor empathizing with the traumatic experiences and……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..

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Bulimia Nervosa in Gorenstein and Comer

Prior to beginning work on this assignment, read the Treatment Plan Preview the document and Case 9: Bulimia Nervosa in Gorenstein and Comer (2014). Please also read the Waller, Gray, Hinrichsen, Mounford, Lawson, and Patient (2014) “Cognitive-Behavioral Therapy for Bulimia Nervosa and Atypical Bulimic Nervosa: Effectiveness in Clinical Settings,†Halmi (2013) “Perplexities of Treatment Resistance in Eating Disorders,†and DeJesse and Zelman (2013) “Promoting Optimal Collaboration Between Mental Health Providers and Nutritionists in the Treatment of Eating Disorders†articles.

Assess the evidence-based practices implemented in this case study. In your paper, please include the following.

Explain the connection between each theoretical orientation used by Dr. Heston and the treatment intervention plans utilized in the case.
Describe the cognitive-behavioral model of the maintenance of bulimia nervosa.
Explain why Rita was reluctant to participate in Dr. Heston’s request for her to keep a record of her eating behaviors. Use information from the Halmi (2013) article “Perplexities of Treatment Resistance in Eating Disorders†to help support your statements.
Recommend outside providers (psychiatrists, medical doctors, nutritionists, social workers, holistic practitioners, etc.) to the assist Rita in achieving her treatment goals. Use information from the DeJesse and Zelman (2013) “Promoting Optimal Collaboration between Mental Health Providers and Nutritionists in the Treatment of Eating Disorders†article to help support your recommendations.
Describe some of the challenges and ethical issues that Dr. Heston may encounter when working collaboratively with the professionals that you recommended. Apply ethical principles and standards of psychology relevant to your description of Dr. Heston’s potential collaboration with outside providers.
Evaluate the effectiveness of the treatment interventions implemented by Dr. Heston, supporting your statements with information from the case and two to three peer-reviewed articles from the Ashford University Library.
Recommend three additional treatment interventions that would be appropriate in this case. The recommended articles for this week may be useful in generating your response to this criterion. Justify your selections with information from the case.
The Case Analysis – Collaborating with Outside Providers

Must be 3 to 5 double-spaced pages in length Bulimia Nervosa in Gorenstein and Comer (not including title and references pages) and formatted according to APA style as outlined in the Ashford Writing Center (Links to an external site.).
Must include a separate title page with the following:
Title of paper
Student’s name
Course name and number
Instructor’s name
Date submitted
Must use at least two peer-reviewed sources from in the Ashford University Library.
Must document all sources in APA style as outlined in the Ashford Writing Center.
Must include a separate references page that is formatted according to APA style as outlined in the Ashford Writing Center.

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Bulimia nervosa case analysis

This paper analyses a case study of bulimia nervosa as exhibited by Rita and treated by Dr.  Heston. It explores the theoretical orientation in the treatment intervention, the cognitive behavioral therapy for bulimia nervosa, resistance to recordkeeping about eating, potential outside treatment providers, challenges and ethical issues in treatment collaboration, and possible additional treatment interventions.

Theoretical orientation of treatment interventions

The first intervention implemented byDr.  Heston regards educating Rita about the etiology of eating disorders. This has various theoreticalorientations that include a psychopathology theory founded on attachment, interpersonal relationships, body perception and emotional processing. Rita took her mother’s words regarding appearing good as a personal challenge, especially considering the closeness of the extended primary attachment between mother and daughter and their consequent interpersonal relationship. Appearing good became the basis of Rita’s body perception, leading to her suffering bulimia nervosa. However, to actually determine the role of attachment in the pathogenesis of eating disorders, multifactorial and process-oriented models need to be established.

The second intervention regarding Rita reading psychoeducation materials and treatment manuals also has a psychotherapy basis in that it relates to cognitive behavior therapy theory that recognizes various processes in the treatment of bulimia nervosa. This include CBT-BN that has both self-help and therapist-assisted approaches. Worth reading too would be interpersonal psychotherapy material that has theoretical and empirical evidence of long-term effectiveness in treatment of bulimia nervosa and other related eating disorders.

The third intervention about Rita monitoring her foodconsumption using a nutritional journal regards Exposure and Response theoretical orientation. Through Rita and the therapist been exposed to the actual food consumption and its effect, they are able to respond appropriately.

The final intervention is about Dr. Heston teaching Rita to identify dysfunctional thinking and to develop healthier cognitions and coping skills. This has the effect of long-term treatment of bulimia nervosa through interpersonal relationship theoretical orientation. It involves viewing flaws in other people with seemingly perfect body weight and shape.

Cognitive behavioral therapy for bulimia nervosa

Cognitive behavioral therapy for bulimia nervosa (CBT-BN) is a twenty-week program that targets binge eating, unsuitable compensatory behaviors and undueuneaseabout body weight and shape. A three-phase program, the first phase of CBT-BN regards psychoeducation about weight and shape, physiological repercussions of extreme dieting, binge eating and purging. Consequently, this phase assists the patient eat regularly and establish an appropriate schedule to monitor their weight.

The second phase focuses on minimizing concerns about weight, shape and dieting behavior. It also aims at identifying antecedents for binge eating and purging with a view to elimination of these behaviors.

The final phase of CBT-BN focuses on planning how to maintain the newly acquired behavior and preventing chances for a relapse.

Treatment resistance

Rita’s severe preoccupation with her body weight was one of the reasons she was reluctant to keep a record of her eating behavior. She feared that she would capture her discordant eating habits and this would make her feel fat. That her self-esteem was pegged to her body weight would also make her feel ashamed of her efforts (or lack thereof) to control her weight.

Rita has issues forming positive relationships that could signal a personality disorder. Indeed, Dr.  Heston refers her to a psychiatrist to help her deal with the issues of interpersonal relationships. In relationship to treatment resistance for people …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….. Bulimia Nervosa in Gorenstein and Comer ……………….

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Hyperactivity Disorder in Gorenstein and Comer

Read the Two Treatment Plan ,Preview the document Case 16: Attention-Deficit/Hyperactivity Disorder in Gorenstein and Comer (2014), and Attention-Deficit/Hyperactivity Disorders in Hamblin and Gross (2012).

Assess the evidence-based practices implemented in this case study by addressing the following issues:

Explain the connection between each theoretical orientation used by Dr. Remoc and the four interventions utilized in the case.
Consider Dr. Remoc’s utilization of two theoretical frameworks to guide her treatment plan.  Assess the efficacy of integrating two orientations based on the information presented in the case study. Describe some potential problems with prescribing medication as the only treatment option for children with ADHD.
Identify tasks and positive reinforcements that might be included in Billy’s token economy chart given the behavior issues described in the case. (There are articles in the recommended resources that may assist you in this portion of the assignment.)
Evaluate the effectiveness of the four treatment interventions implemented by Dr. Remoc and support your statements with information from the case and two to three peer-reviewed articles from the Ashford University Library.
Recommend three additional treatment interventions that would be appropriate in this case. Use information from the Hamblin and Gross “Attention-Deficit/Hyperactivity Disorders†chapter to help support your recommendations. Justify your selections with information from the case.
The Case Analysis

Must be 4 to 5 double-spaced pages in Hyperactivity Disorder in Gorenstein and Comer length (not including title and references pages) and formatted according to APA style as outlined in the Ashford Writing Center (Links to an external site.).
Must include a separate title page with the following:
Title of paper
Student’s name
Course name and number
Instructor’s name
Date submitted
Must use at least two peer-reviewed sources from the Ashford University Library.
Must document all sources in APA style as outlined in the Ashford Writing Center. (Links to an external site.)
Must include a separate references page that is formatted according to APA style as outlined in the Ashford Writing Center.

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ADHD treatment plan analysis

This paper analyzes the case of a treatment plan for Billy who is suffering from Attention-Deficit/Hyperactivity Disorder, Combined Form (ADHD-C). It looks at the theoretical framework informing the treatment plan, integrating medication and behavioral therapy, token economy, and treatment interventions. 

Theoretical framework

As reflected in the long-term goal of the treatment which is to “demonstrate marked improvement in impulse control”, Dr Remoc leans towards psychological theories that focus on impulsiveness. This posit that the poor inhibition caused by brain’s inhibited activity leads to delay or failure to inhibit a behavioral response. Depending on the energetic level of the affected person, there is low inhibition in some situations. Inhibition or activation of a response mostly arises from environmental stimuli.

That Dr. Remoc adopts medication and behavioral interventions means that she also utilizes Barkley’s theory that recognizes the neurocognitive processes of a person with ADHD. It is a unifying theory of most ADHD theories positing that low inhibition in persons with ADHD affects effective operation of working memory, speech internalization, self-regulation of affect, motivation and arousal and reconstitution (Berlin, et al. 2004). This in turn negatively affects motor control or fluency syntax.

Integrating medication and behavioral therapy

Dr. Remoc integrates utilization of both medication and behavioral treatment as interventions in Billy’s case. This ensures that the patient is able to be treated faster since stimulant drugs act to slow down and focus the patient. He is hence able to profit more from the procedures and rewards of behavioral treatment. Indeed, combination of boththerapies has been proved to be more effective than utilization of one or the other treatment. If Dr. Remoc was to prescribe medication only, it may only treat the ADHD symptoms afflicting Billy without having any effect on his behavior. Moreover, prolonged use of the drugs, more than the prescribed period e.g. six months for methylphenidates, is likely due to slow effects in altering the situation, leading to drug dependency.

Billy will eventually receive medication holidays, gradually being weaned from the drugs to avoid dependency. In such a situation, it is important that behavioral therapy fully takes over. Further, parents also usually exhibit positive attitudes to behavioral treatment from the onset, as compared to their attitude towards medication, which various research has shown that it only manifests as positive therapy after completion of the dose.

Billy’s token economy

Some of the tasks that need to be included in Billy’s token economy chart include paying attention in class and at home, listening and following instructions, sitting still for several minutes, successfully completing classroom activity, waiting for their turn in class and play, and listening and appropriately responding to the teacher and friends. Some of the activities that Billy can be encouraged to achieve include completing their classwork and homework, listening to and obeying the teacher, being polite and friendly to other people, sharing an…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….. Hyperactivity Disorder in Gorenstein and Comer ….

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